How do I resolve my dog’s chronic ear infections?

Hi Renee,

Thanks for you question.

This is an extremely common and very frustrating situation that I see a lot of good pet owners experience. It is likely that these are not recurrent infections, but rather the same infection that is not adequately treated.

Here are the different points I would make to help you resolve this:

1. Figure out what the infectious agent is.  I cannot overstate the importance of this. There are a lot of veterinarians who will simply hand over an ear medication off the shelf and have you apply it in the ear twice a day for a week or more, without ever doing a test. I HIGHLY recommend you perform a very quick test called ‘ear cytology’. Your vet will swab the ear and look at it under a microscope. They will be able to tell if there are mites, yeast, and/or bacteria present.

***I have seen many cases of yeast infections in the ear that go unnoticed for years and people just keep medicating the infection without curing the infection. Some medications simply calm the ear for a few weeks or months until the same infection flares up again.

2. Have a culture and sensitivity test performed. I also recommend, in cases of chronic ear infection or when puss can be seen by your veterinarian during an otoscopic exam to have a ‘culture and sensitivity’ test be performed. Your vet can do this test by swabbing the ear and sending the swab to a lab where over the course of a few days, it is plated and incubated. All the bacteria present will grow and then they are exposed to tablets of different antibiotics to determine which ones will kill the bacteria. I cannot overstate how important this test is when dealing with a chronic recurrent infection of any kind. It will direct the treatment so specifically that it will be a lot more successful.

Let me give you an example. I once saw a woman who brought a dog to me that had really terrible ear infections for the past 8 years. She literally brought every veterinary bill she had over the 8 years from more than 5 different veterinarians and the infection had never gone away. She brought the bills to show me all the different medications she had been given in the past. She asked me…’what medicine are you going to give me that I haven’t already tried.’ I told her I wasn’t going to give her a medication. I simply performed the ear culture and sensitivity. It grew bacteria that were resistant to every single medication that had ever been administered to the dog in the 8 years. If someone had done this test 8 years earlier, the owner could have saved thousands of dollars in vet bills. I ordered a medication with the very specific antibiotic in it that the test showed was effective against the particular bacteria in the dog’s ear. The infection, after 8 years, finally resolved within 6 weeks of seeing me. It is vital that we know what we are treating before we initiate a plan.

3. Consider a compounded medication. Not all veterinarians will use these, but they should all know about it. This is a medication made by a ‘compounding company’ and ordered individually based on the results of the tests. These medications are often cheaper, stronger, more specific to your pet’s infection and the viscosity is less so it will run down into the ear much better than typical commercial products that are on the pharmacy shelves at a veterinarians office. By ordering a compounding medication, your veterinarian can tailor make a medicine for your pet’s particular infection and save you money in the meantime.

4. Treat for long enough and perform frequent re-examinations. I commonly see that an owner or veterinarian will only treat an ear infection for a week. It will calm the ear and the symptoms but often it only partially kill the bacteria present. After a few weeks or months, the infection comes back and many vets and owners just think it’s another infection where in fact, it is the same infection that was never completely treated in the first place. Re-examinations are vital in many cases. I recommend that you return to your veterinarian at the end of the treatment regime and have them inspect the ear canal. This allows them to CONFIRM that the infection is cured. In some cases, a small plug of puss and wax could remain and the dog can be completely symptom free, but that plug of debris has residual bacteria, yeast or mites that will simply start to grow back. Re-checks ensure that you have achieved success and that the condition won’t return.

5. Consider oral medication as well. In the case of chronic recurrent infections, it’s important to consider administering an oral antibiotic and oral anti-inflammatory to help the topical ear medication to successfully treat the ear infection.

6. Learn how to perform a proper ear clean.  In cases of even simple infections, I always take the time to demonstrate a thorough ear clean for my pets and I encourage you to take a look at our video tutorial “How to Properly Clean a Dog’s Ear”. Again, I can’t overstate the importance of this. If you are not cleaning the ear properly, it can significantly contribute to treatment failure. Ask your veterinarian if their staff can demonstrate a proper ear cleaning procedure to you or at least watch our video about how to perform this.

7. Consider the possibility of allergies. Pets can have allergies that cause inflammation in the ear canal and precipitate the right conditions for infection to happen. If this is present, you’ll have recurrent infections unless your vet identifies this and gives you a plan to keep the ear inflammation under control. You can use a simple and cheap topical anti-inflammatory ear medication on a semi-regular basis to control this so an infection doesn’t occur.

I hope this helps and good luck.

Dr. Clayton Greenway